Graduate training in body image complexity: Evolving competence to meet emerging research

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 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.