Wednesday, December 9, 2015

Looking for a Fat Friendly Therapist in a Fatantagonistic World

I was reading an excellent article by Terrence Chappell on the presence of white privilege in therapy today, and it struck a depressingly deep chord.  While I'm not black, and so experience different kinds of prejudice, the fat bias I experience has made it really hard for me to find a decent therapist, or even feel safe trying one on for size.

Several years ago, when I briefly had insurance,  I went looking for a therapist to help me cope with the aftermath of my abusive marriage. I found a nice woman who did art therapy (although not with me), and whom I got along with in most senses. While she focused more on my childhood than my marriage, that was partially because I was still trying to be friends with my ex and had trouble really talking about what he'd done. That's arguably part of why I needed therapy, and a better therapist would have helped me get there, but she wasn't up to the job.Be that as it may, her inability to help me sort out my trauma wasn't her biggest issue. The real problem was her fixation on my weight.

This was before I was really aware of fat acceptance.  While I was better with myself than I had been when I was with my ex, I still hadn't come to the realization that I didn't owe other people my body looking any particular way.  However, her preoccupation still was strange and upsetting to me. She wasn't my medical doctor, but she was pushing me to get surgery. She kept coming back to it again and again. I think now that she liked me and was trying to "fix" me so that liking me would be okay. I didn't fit her idea of what a fat person should be, so she tried to make me not fat. Eventually my therapy was more about my weight than about helping with either the emotional issues from my childhood or the ones I'd gone there to get help for.  I never confronted her about this; I'm not sure I could have at the time.  I just eventually pleaded financial constraints and stopped going.
That therapist was a sweet, well intentioned person. She wasn't perfect, but she wasn't trying to harm me; she was just part of our culture and believed that everyone always needs to be thin, no matter what the cost, and that fatness is inherently bad. She believed that she needed to save me, that I wasn't like all the other bad fatties out there, that I uniquely deserved to be thin.
I've dealt with much worse. There was the nurse practitioner who asked me if I really had a endocrinological problem or if I just had a huge appetite. There was the doctor who told me that pain in my arms was just because I was too fat. There was the pediatrician who didn't test me for hypothyroidism because it was "overdiagnosed" in children. Medical bias is a huge thing for fat people and for women (and woe betide those of us who have the intersection) and it is a similarly huge issue for people of color, LBGTQ+ folks, and members of other oppressed groups.
However, it's a much more intimate problem in therapy, and at least as damaging to treatment. When I walk into a therapist's office, I'm very aware that I'm a fat, bisexual woman. Almost any therapist I could work with would differ from me on at least one of those three axis. I narrow that problem somewhat by only working with women, but I still am fat and bi, There are probably plenty of bi therapists, but the only fat one I've worked with was my awesome therapist from high school, and even she had a lot of internalized fatantagonism..
People go to therapy to become their better, healthier, happier selves. In my case, I want to be free of some of the crippling anxiety and trauma left over from my marriage. I also want to deal honestly with my feelings about being fat, which are extremely complicated. I have anger at our culture and most people in it for treating me like I'm lesser. I have internalized fatantagonism. I have health concerns and mobility concerns that I want to talk about without getting unwanted advice. I don't need the advice; I need the conversation. I have grief for the loss of all the work I did to lose weight years ago to no lasting avail. I have overwhelming exhaustion and a realistic knowledge of current research on weight that contributes to my depression. I have all the spaces I don't fit in, all the things I can't do, all the places I can't go.
I need to talk about these things and work through them, and for that I need someone who's not going to be invested in pushing me towards the diet industry or surgery or anything else. I need someone to facilitate me making my own choices, and I don't know how to find that because our culture hates fatness so much that I feel like any acknowledgement of ambivalence or complexity of feeling will be taken as proof that I need to be thin, that fatness is bad, evil and wrong and thinness is good, true and right.

A couple months ago, I decided to start looking for a therapist again.  I'm about to visit the third I've tried out since.  The first was pleasant enough but kept losing my appointments.  The second had troubling ideas about domestic violence.  While that would have been enough reason to disqualify her, she also made a face and half covered her mouth when I talked about fatantagonism, as though she was preventing herself from saying something.  It doesn't take a genius to guess what.  I don't have much - or really any - hope that this next one will be different.  I'm going to see her because I know I need a therapist, because I know that having a good therapist would be incredibly helpful for me, and because I promised my husband I'd take care of myself and this is part of that commitment.  It would be really, really nice to be proven wrong.  
Every time I walk into a new doctor's office I brace myself,  I know that there's a fair chance I'll be explicitly or implicitly fat shamed, that I'll have to advocate to get basic, reasonable treatment, that I may not receive treatment at all.  However, most doctors can do the basic things like draw blood, prescribe drugs, and so on.  Even the most fatantagonist doctor is capable of providing care.  They might fail to do so, or provide inadequate care, but ultimately when they send my blood out for a blood test the results will be as valid as those a thin person would get.  The problem is convincing them to offer the care in the first place, not an inability to provide it.

By contrast, a therapist who has a bias against my body cannot provide me care no matter how well intentioned she may be because her vision of both my experiences and who I should be fundamentally conflicts with mine and erases much of the pain I need to address.  A therapist who cannot accept and respect my other identities - fat, bi, woman, feminist - can never help me become the person I desperately want to be.