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Graduate Training in Body Image Complexity: Evolving Competence to Meet Emerging Research a Dissertation Submitted in Partial Fu

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Graduate Training in Body Image Complexity: Evolving Competence to Meet Emerging Research a Dissertation Submitted in Partial Fu GRADUATE TRAINING IN BODY IMAGE COMPLEXITY: EVOLVING COMPETENCE TO MEET EMERGING RESEARCH A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF TEXAS WOMAN’S UNIVERSITY DEPARTMENT OF PSYCHOLOGY AND PHILOSOPHY COLLEGE OF ARTS AND SCIENCES BY SAMANTHA R. LEE, M.S. DENTON, TEXAS AUGUST 2019 DEDICATION It is in moments like this one, reflecting on the journey that has brought me to the close of one adventure and the beginning of another, that I find myself filled with gratitude for those who have accompanied me along this path. This project is dedicated to my loved ones who have served as my guides, companions, mentors, and friends. Sharing this life with you has been my greatest joy. First, I must thank the person who opened my life to a world of possibilities through her own journey of strength and perseverance in earning an advanced degree. To my mother and friend, thank you for embodying grace, compassion, and strength, and in the process, giving me permission to discover my own. To my husband, friend, and life-long fellow adventurer, I am eternally grateful for the joy you bring to my life on a daily basis. Thank you for speaking life into my passions, for walking alongside me through the mountains and valleys of our life together, and for reminding me of what truly matters. To my dearest friends, thank you for joining me in the moments of tears and of laughter, for loving me from a place of shared humanity, and for helping me grow in my understanding of myself. To Julia, my kindred spirit, thank you for lighting my path with your unwavering support and unconditional love; to be truly known is the magnificent resting spot at the end of a long journey. To my grandparents, it is a rare gift to find a love that inspires and encourages, and reminds people of the light they carry within even when they lose sight of it ii themselves. Your presence in my life has been a divine gift; in the love we share, I have always had a home. Thank you for believing in me and reminding me of who I am and where I come from. To my siblings, no matter how far the winds of life take us, may we always find our way back to one another and remember the strong bonds that have tied us together. You are the inspiration for Elizabeth Kübler-Ross’ perspective that “beautiful people do not just happen”; rather, beautiful people bring a unique kindness and love to the world born out of the depths of their own experiences. Thank you for sharing your beauty with me. May you use that same beauty to light up the world. I love each of you deeply and am eternally grateful for the divine gifts your presence has brought to my life. Everything I accomplish and all that I become I owe to you. iii ACKNOWLEDGMENTS To the Chair of my dissertation, Debra Mollen, Ph.D., thank you for fostering broad and celebratory perspectives of cultural diversity through your courses and, in doing so, igniting a passion within me that later developed into the inspiration for this project. I am grateful for your thoughtful feedback, dedication, enthusiasm, and intentional investment in each of your students. To committee member, Martha F. Bergen, Ph.D., thank you for the warmth and compassion you embody through your work as a clinician, supervisor, mentor, and friend. I am grateful for your contributions of expertise, encouragement, and zest. To committee member, John Terrizzi, Ph.D., thank you for your patience, expertise, and enthusiasm. Your contributions as a statistician were invaluable to the development and enactment of this project. May you continue to encourage students to think creatively and to challenge themselves to grow beyond the confines of their own worldviews. To committee member, Sally Stabb, Ph.D., thank you for your insight, expertise, and dedication. You introduced me to qualitative approaches to research and in doing so, inspired me to view research creatively. Thank you for helping me along my journey to discovering my identity as a researcher. To the staff at TWU CAPS, you provided me with an invaluable gift that I will aspire to recreate through my own work as a clinician, supervisor, educator, and advocate for years to come. Thank you for gifting me with an atmosphere that celebrates diversity, iv builds bridges and fosters connection founded in shared humanity, and encourages an integration of the personal and professional. I will forever be a more effective and compassionate clinician because of the genuine and intentional care you invest in each of your practitioners. This project was strengthened by each of your contributions, as was my professional development. Thank you for joining me on this journey. v ABSTRACT SAMANTHA R. LEE GRADUATE TRAINING IN BODY IMAGE COMPLEXITY: EVOLVING COMPETENCE TO MEET EMERGING RESEARCH AUGUST 2019 Positive psychologists and feminist theorists have advocated for a paradigm shift from pathologizing conceptualizations of body image to growth-fostering and celebratory approaches. The researcher conducted an exploratory examination of graduate training in body image topics by soliciting training directors and current students from the 339 counseling and clinical psychology programs accredited by the American Psychological Association (APA) and the Canadian Psychological Association (CPA). Participants completed the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS; Brown, Cash, & Mikulka, 1990), the Attitudes About Treating Larger- Bodied Clients/Patients Scale (Puhl, Latner, King, & Leudicke, 2014), and a training and education survey designed for this online study to assess perspectives toward integration of body image considerations in practice and exposure to pathologizing and affirming training. The researcher hypothesized that (1) training in body positivity and celebration of body diversity would be rare with a focus on pathological concerns more prevalent; (2) perception accuracy would be covered more frequently than the relationship between body image and mental/physical health considerations; (3) counseling psychology programs would cover size as a cultural variable more frequently than clinical vi psychology programs; (4) programs with a focus in social justice and/or multiculturalism would cover body image and size topics more frequently than programs without a social justice/multicultural focus; (5) trainees who received more training in body image topics would endorse less weight bias in practice; and (6) trainees with higher body esteem would endorse less weight bias in practice. The researcher utilized correlated groups t- tests, independent sample t-tests, and Pearson correlations to test her hypotheses. Descriptive and exploratory analyses were also conducted. Results provided mixed support for the researcher’s hypotheses and indicated that students were exposed to pathological more than positive topics and mental and physical health was emphasized more than size perception accuracy. No significant differences were evident between counseling and clinical programs and no relationship was evident between exposure/body esteem and endorsement of bias. Qualitative analyses revealed notable trends in trainee self-perceived incompetence in practice and limited encouragement of self-reflection in training pertaining to topics of body image. Limitations, implications for practice, and areas for future research are discussed. vii TABLE OF CONTENTS Page DEDICATION ................................................................................................................. ii ACKNOWLEDGMENTS .............................................................................................. iv ABSTRACT .................................................................................................................... vi LIST OF TABLES ......................................................................................................... xii Chapter I. INTRODUCTION ...................................................................................................1 Overview .............................................................................................................1 Limitations in the Research ...........................................................................3 Research Questions .............................................................................................3 Definition of Terms ............................................................................................4 II. LITERATURE REVIEW ........................................................................................9 Body Image: An Evolving Construct................................................................10 History of Scientific Inquiry .............................................................................12 Embodiment ......................................................................................................14 Self-Objectification ......................................................................................15 Body Positivity .................................................................................................19 Intersectionality ................................................................................................21 Men and the Muscular Ideal ........................................................................22 Transgender Populations..............................................................................23 Size as a Cultural Construct ..............................................................................25
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