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Positive Body Image Workbook
Positive Body Image Workbook
A Clinical and Self-Improvement Guide
Nichole Wood-Barcalow, PhD
Tracy Tylka, PhD
Casey Judge, PhD
University Printing House, Cambridge CB2 8BS, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre,
New Delhi – 110025, India
79 Anson Road, #06–04/06, Singapore 079906
www.cambridge.org
Information on this title: www.cambridge.org/9781108731645
DOI: 10.1017/9781108758796
Cambridge University Press © 2021
This publication is in copyright. Subject to statutory exception and to the
provisions of relevant collective licensing agreements, no reproduction of
any part may take place without the written permission of Cambridge
University Press.
First published 2021
Printed in the United Kingdom by TJ Books Ltd, Padstow Cornwall
A catalogue record for this publication is available from the British Library.
ISBN 978-1-108-73164-5 Paperback
Cambridge University Press has no responsibility for the persistence or
accuracy of URLs for external or third-party internet websites referred to
in this publication and does not guarantee that any content on such
websites is, or will remain, accurate or appropriate.
...........................................................................................................
Every effort has been made in preparing this book to provide accurate and
up-to-date information that is in accord with accepted standards and
practice at the time of publication. Although case histories are drawn
from actual cases, every effort has been made to disguise the identities of
the individuals involved. Nevertheless, the authors, editors, and
publishers can make no warranties that the information contained herein
is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors,
editors, and publishers therefore disclaim all liability for direct or
consequential damages resulting from the use of material contained in
this book. Readers are strongly advised to pay careful attention to
information provided by the manufacturer of any drugs or equipment
that they plan to use.
Contents
Foreword vii
Acknowledgments x
Online resources
All assignments from the book are available to download
and print for use in sessions via: www.cambride.org/PBIW
Password: PBIWorkbook21
v
Foreword
For 33 years I taught abnormal psychology, introductory psy- middle school resumed in the fall (see the epigram at the
chology, and an upper level seminar on eating disorders at a beginning of chapter 22). And a mere 2 years later the Beatles
liberal arts college. Most of the students I taught were in the top and their “mop top,” ear-obscuring hair became an interna-
10% of their high school classes. Around 75% eventually went tional sensation, and a sexiness ideal for White boys in middle
on to graduate school and/or professional training in fields and high school, including those of us with curly hair . . . .
such as psychology, medicine, law, the arts, or business. Body image. Body dissatisfaction. Shame. Should. Ought. If
Typically, the students were very bright, curious, and analyti- only I looked like . . . . A few words, easily processed and
cal. We had lively, sometimes boisterous discussions, often with elaborated in cool, conceptual form (e.g., actual-ideal dispar-
personal examples, of a great many topics. These included lan- ity) while reading about and in some instances discussing these
guage, symbolism, and Freudian psychosexual stages; the plea- topics. But where to begin—as a person who wants to be
sures, hilarity, risks, and all too frequent tragedy of alcohol and healthier, as a grand/parent determined to resist imposing
other drug use; and people we have known—and, in some sad their past and the culture’s stifling present on children, as a
instances, grown up with—who had The Dark Triad of person- counselor or a coach or a physician who wants to be a positive
ality characteristics (Furnham, Richards, & Paulhus, 2013): nar- influence—to understand the hot emotionally and morally
cissism, subclinical psychopathy, and Machiavellianism. Only charged layers of body image? The whole matter is complicated
one topic, from fall 1980 through spring 2012, unfailingly evoked by the fact that the geography of body image reflects an unruly
uncomfortable silence. If your first thought is trauma, think and set of influences ranging from genetics, to teasing, to trauma,
feel again. to gender/sexual identity, to advertising as it represents eco-
Body image was and remains for most people simulta- nomic and political forces.
neously too personal, too interpersonal, and too complex. It It’s hardly sage advice for me to offer you Internet platitudes,
is freighted with strong emotions, it is deeply rooted in our past such as “Stop. Breathe deeply. Step up, be mindful, and begin
while always lurking in the immediate future, and it is influ- somewhere. Love yourself. Embrace health. Be the change you
enced by a network of powerful forces in our cultures. When wish to see in the world . . .” But “Read and use the Positive
“body image” became the focus of that social phenomenon we Body Image Workbook” is not only sage advice, it is a compas-
call a “college class,” one could almost see and smell the self- sionate, effective, and socially constructive move on my part.
consciousness and shame seep into the room, like foul-smel- In fact, this is a book not only to be read, it calls us to engage
ling smoke under a door. with it mindfully, frequently, and in an intentionally recursive
I offer this observation neither as an experienced college way. Whether you are a curious teenager, a frustrated 30-
professor nor as a body image expert. Standing or sitting something dieter, or a pediatrician, this book is a unique and
with my students in class I experienced it, too. Every time. rich means of beginning to learn and practice the very skills
And right now in memory, as the adult form of a small, necessary to improve our own body image, those of people we
physically frail boy growing up in 1950s and 1960s southern know and care about, and our societies in general. And, ulti-
California, with big ears, easily irritated skin, and curly hair mately, the Positive Body Image Workbook will likely enable
and long eyelashes that girls envied, right above eyes that you to “love yourself” and “be mindful” and “embrace health”
necessitated glasses at age 7 . . . a mere 2 years after I really and “be the change you wish to see in the world.”
began to need them. In the early 1960s, puberty and acne With its focus on skills and learning as they apply to each
underway, I and my misery/shame/helplessness prevailed person, this book is, in the words of Dr. T. Aaron Beck, founder
upon my thrifty middleclass parents to give money and time of Cognitive Therapy, person-centered and problem-focused
they could ill afford to securing for me what was then called (Beck, Rush, Shaw, & Emery, 1979). In this regard, I call your
“plastic surgery.” At a hospital 50 miles away in Los Angeles attention to the chapter that covers one important aspect of
the bones in my “hey, there’s Dumbo!” ears were rearranged in positive body image: body acceptance. Chapter 6 of Positive
order to set them back toward my head. This helped for a while, Body Image Workbook exemplifies how this book helps each
although I wonder how many of my peers noticed, really, when reader as an individual to understand, accept, and overcome
vii
Foreword
without a wasteful, self-critical fight the neurotic dynamics of healthy, sustainable changes toward body positivity within a
negative body image, that is, the self-defeating and self-perpe- fuller life. This book literally enables you to practice engaging,
tuating vacillation between dysphoria (shame, anxiety, guilt), instead of avoiding, the dialectic between acceptance of the
avoidance, and rumination. The Positive Body Image unchangeable and commitment to applying skills for what can
Workbook directly, matter of factly, and compassionately be changed—and the proverbial wisdom to know the differ-
helps the reader to identify nonjudgmentally and then address ence. This encouragement is particularly important for
the many external and internal forces that threaten and some- approaching one’s body image, which may feel intractable.
times overwhelm body acceptance. This book itself, infused Tracy, Nichole, and Casey are authoritative—knowledgeable
with the wise voices of its authors, is a great foundation, in and nurturing—throughout this book. They also consistently
terms of modeling, advice, knowledge, and support, for begin- serve as models for the courage to change. They know the task
ning to build and participate in what the authors call a of transcending the past and the culture (not to mention the
Community of Acceptance (see chapter 17). self) is daunting. They know there will be experiences of con-
The methodology of the Positive Body Image Workbook is fusion, anxiety, and shame, and they know there will be set-
grounded in a flexible form of therapy, teaching, and strategic backs. And in every chapter they are willing to be there—and
encouragement that emerged nearly 100 years in the decidedly for us to join them in the enterprise—with their healthy values
non-Freudian eclecticism of Alfred Adler (1929). Adler’s and to stay present and mindful, and to take action, all in the
approach to therapy, education, and indeed social change presence of anxiety, doubt, and humility.
combined brief lectures, guided discussion, analogies, stories, I was initially a bit reluctant to agree to write a foreword
homework assignments, humor, and careful, multifaceted ana- about a “workbook,” even though I have known, admired, and
lysis of cognitions we accept as painful, suffocating truths drawn upon the work of Tracy and Nichole for over 15 years.
instead of the mis/guiding, malleable fictions they really are. After all, I am not a clinician, I was trained to be suspicious of
And yet the Positive Body Image Workbook couldn’t be more anything that was not a peer-reviewed journal article, and, yes,
rooted in and guided by current research and evidence-based I’ve spent too many painful hours either avoiding or ruminat-
practices to reducing negative body image while developing a ing about my own body image issues. And as an advocate for
positive body image. I counted explanations, guidance, and the prevention of negative body image and disordered eating, I
exercises, from, in alphabetical order: Acceptance and believe in the prospect and the psychosocial significance of
Commitment Therapy (ACT), Behavior Therapy, Cognitive positive body image, and I need to practice being courageous.
Therapy, Cognitive Behavior Therapy (CBT), Dialectical I found, to my delight, that in reading the Positive Body Image
Behavior Therapy (DBT), Feminist Therapies, Health at Workbook I had the privilege of learning much more about
Every Size® principles, Media Literacy, Mindfulness-Based negative body image (e.g., self-objectification; chapter 13) and
Therapy, Motivational Interviewing, and Stress Inoculation positive body image (e.g., protective filtering; chapter 17). I
Training. These are integrated by the book’s systematic yet also had the “life-enhancing” (see chapter 21)—personally,
flexible approach to helping people make significant changes professionally, politically—opportunity to discover in each of
and by the wisdom of the authors, drawing on their vast the 23 chapters four of the pillars holding up the foundation of
experiences in research, clinical work, and self-reflection. positive psychosocial development, of which positive body
Another truly unique aspect of the Positive Body Image image is so clearly a major dimension.
Workbook is its layered approach to self-assessment. This fea- The first pillar is compassion for the complexity, confusion,
ture derives from the authors’ expertise, and in some instances and challenges evoked by “working” in any manner, including
their leadership, in the science of tests and measurements for use of a workbook, on body image. The authors understand, at
assessing facets of body image. The authors guide the reader in all levels, that body image is not “just” anything. Rather, it is a
self-assessment—and thus a deeper understanding of impor- fascinating but bewildering network of beliefs, strong feelings,
tant constructs—by making extensive use of valid question- sensations, visual images, auditory echoes, and, to paraphrase
naires and opened-ended, semi-structured questions. At the Carl Jung (1965), “memories, dreams, and reflections.”
simpler levels this connects with the reader’s desire to under- Moreover, all these important dimensions are embedded in
stand multidimensional concepts more fully and how they transactions with how we behave and the contexts in which we
apply to the self. Here there is guidance for scoring question- live. Second, the authors, by virtue of their extensive years of
naires and interpreting total scores. However, two truly dis- research, clinical work, advocacy, and self-reflection, have the
tinctive features of the Positive Body Image Workbook skills to provide us with the specific skills we personally need to
constitute the more complex levels. One is inviting the reader (a) understand the positive and negative dimensions of body
to return to their responses to individual questionnaire items image, and then (b) gently and fiercely tackle the challenge of
to explore those responses, as well as the productive potential long-term change while embracing the process of discovering
inherent in alternative responses. This sets the stage for the what positive body image means to us in the context of our
transition to using such in depth self-assessment for goal- own body agency.
setting and for anticipation of both supports and obstacles. Third, along with compassion, the authors infuse this work-
Without either complicating or oversimplifying the task, the book with the determination, reinforcement, humor, and
Positive Body Image Workbook provides, in clear steps, the patience necessary to help people learn through doing that
perspective, the motivation, and the skills necessary for change is a practice. This is the rare workbook that is well-
viii
Foreword
researched by world-class experts and well-organized by scien- memory, but well into pain that can be all too fresh. This book
tists who are clear thinkers and effective writers. And these has provided me with knowledge, inspiration, self-compassion,
authors know that to use this workbook effectively, one has to skills, and more, including the willingness to learn and practice
do what one does while engaged in any process of meaningful embodying its important lessons.
change—go back and forth, across the chapters, across the
exercises, across the years of one’s life, across the skills, across – Michael P. Levine, Ph.D., FAED
the dialectic between acceptance and change. This leads to the Goleta, California, 9 March 2020
final pillar, which is the importance of being guided by experts
who are part of a community in which they themselves con- Adler, A. (1929). The practice and theory of individual psychology
tinue to develop personally, professionally, and politically in (Rev. ed.). London: Kegan Paul, Trech, Trubner & Co.
terms of the power to transform a world that all too often Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive
makes positive body image sound preposterous. therapy of depression. NewYork: Guilford Press.
I am a psychologist who works in the body image and eating Furnham, A., Richards, S. C., & Paulhus, D. L. (2013). The Dark Triad
disorders fields. As noted, I am also an advocate for prevention of personality: A 10 year review. Social and Personality Psychology
of eating disorders and related conditions, including body Compass, 7, 199–216.
dissatisfaction. And I am a 70-year-old husband and father Jung, C. G. (1965). Memories, dreams, reflections (A. Jaffé, Ed.). New
whose body image issues stretch sideways and back beyond York: Vintage Books.
ix
Acknowledgments
x
Section I Introduction and Preparation
Chapter
Introduction to the Positive Body Image Workbook
1
Welcome to the Positive Body Image Workbook! In this chapter, workbook) as well as our clinical experience of witnessing
we offer an overview of positive body image, introduce our- clients transform from negative to positive body image.
selves and our work, share what inspired us to write this work-
book, and describe how you may use it in your clinical practice Who We Are and Our Guiding Beliefs
(for clinicians1) and everyday lives (for clients and readers2).
We are three colleagues and friends who have collaborated on
published studies related to body image, intuitive eating, and
What is Positive Body Image? disordered eating, and have provided services (including psy-
This workbook focuses on increasing positive body image and chotherapy and trainings) focused on promoting positive body
reducing negative body image. Right now, you may be wonder- image. We share similar values (integrity, collaboration, and
ing, “Won’t reducing negative body image automatically quality research and clinical work) and a passion to help all
improve positive body image?” In some ways, yes – but not in those who want to move toward positive body image. We
all ways. Negative body image includes negative feelings and believe that positive body image is attainable for any and all
thoughts about our appearance. Positive body image is broader who are willing to commit and invest in it.
than simply “positive feelings and thoughts about our appear- We each have our Ph.D. in counseling psychology,
ance.” Positive body image includes appreciating our bodies in a discipline that focuses on individual strengths to help build
terms of how they function along with appearance. It means resilience when faced with challenges while also promoting
loving our bodies for their unique characteristics, which may meaningful and fulfilling lives [1]. We draw from positive psy-
change across time (e.g., “our scars are beautiful”). Holding chology, the scientific study of human strengths that help people
a positive body image means that we perceive a wide range of thrive and cultivate what is best within themselves [2].
appearances as beautiful, not just the bodies portrayed as attrac- Incorporating strength-based approaches into clinical treatment
tive in social media, magazines, TV, movies, etc. Positive body enhances outcomes beyond focusing solely on what is wrong [3].
image also includes how we “bounce back” from body image Counseling psychologists honor multiple social identities (e.g.,
threats (or attacks on body image), such as negative comments race, gender, class, age, weight, sexual orientation, gender iden-
made about our bodies. Positive body image can be expressed as tity, ability, etc.), explore how these social identities interact to
taking care of our bodies (e.g., self-care), showing the world that shape experiences, and work to dismantle discrimination and
we feel positively about and respect our bodies, and mentoring stigmatization.
others to hold a positive body image as well. And, as you will Our professional and personal identities shed light on the
see in this workbook, it is so much more. perspectives we bring to this workbook. We have had experi-
Some people believe that it is unrealistic to have a positive ences with both privilege and disadvantage throughout our
body image. This skepticism is related to a narrow definition of lives which shape our worldviews, and as a result, how we
positive body image: “loving every aspect of the body at all view body image work. We offer some of our guiding beliefs:
times” without experiencing discomfort or moments of negative • Positive body image is unique from negative body image.
body image. We agree that this outcome is unachievable when • Positive body image is attainable for all persons of varying
defined in this way, especially in cultures that value appearance social identities.
ideals. Furthermore, we acknowledge that we all have moments • It is important to focus on changing internal experiences of
in which our body image is not what we would like it to be. Our body image rather than external appearance. The problem
definition of positive body image, in contrast, includes loving with negative body image is not about the actual body itself
and accepting our bodies regardless of appearance and function- but rather viewing oneself as deficient or unacceptable. As
ing, showing compassion for differences and difficulties, and a result, we do not recommend weight loss goals for body
responding effectively when body image distress occurs. This image issues, given that weight and body mass index (BMI)
definition is based on research studies (which we provide in this
1
We refer to all professionals who work with clients who have body image concerns as “clinicians” to honor the diversity of professionals in this
area (e.g., psychologists, counselors, social workers, dietitians, nurses, psychiatrists, medical doctors, and more).
2
Those engaged in therapy are referred to as “clients.” The term “reader” is for anyone who is interested in using this workbook for self-
improvement.
1
Introduction to the Positive Body Image Workbook
are rather poor indicators of health [4–5]. Instead, we We include assessments along with instructions and
promote self-acceptance and compassion. applications for your clients to use at different points of
• Biological issues and maladaptive behaviors (e.g., chronic treatment to gauge and demonstrate progress (e.g., clients
dieting, self-induced vomiting, excessive exercise) need to be can witness first-hand their objective change, substantiate
recognized and addressed in advance of body image work. gains to third party payors). We intentionally incorpo-
• Negative body image is, in part, a byproduct of societies that rated elements of various treatment modalities so that
idealize appearance and that treat individuals differently this workbook would be interesting and applicable to
based on weight and body size, with higher-weight clinicians with different theoretical orientations:
individuals often experiencing weight stigma. We advocate Cognitive Behavioral Therapy [6], Dialectical Behavior
to reduce weight stigma (as well as other types of stigma) at Therapy [7], Acceptance and Commitment Therapy [8],
various levels (e.g., societal, individual). Emotion-Focused Therapy [9], Compassion-Based
• A weight-inclusive philosophy (supporting the well-being Therapy [10], Interpersonal Therapy [11], Exposure
and health of people of all body sizes) is essential for moving Therapy [12], social justice [13], and Motivational
toward positive body image. Interviewing [14]. The assignments included in each
• Clinicians benefit from exploring how their own body image chapter can be reviewed during sessions and/or offered
issues impact themselves and the clients with whom they as homework assignments to assist your clients in moving
work. toward positive body image.
• Self-care (e.g., consistent nourishment, life-enhancing Of special note, we devote an entire chapter (Chapter
movement) is the essence of moving toward positive body 3 – “Clinician Preparation”) focused on how to help clients
image and requires intentional effort and practice. move toward positive body image within your clinical
work. We also offer specific considerations and assign-
ments for you as the clinician to promote introspection
Inspiration, Vision, and Integration into how your personal experiences intersect with that of
The inspiration for this workbook emerged many years ago your clients.
while Nichole contemplated how to share with fellow clinicians For the client and general reader: We offer factual infor-
and clients alike her process of synthesizing research concepts mation about positive body image that is based on research and
about body image into clinical practice. The vision was to clinical expertise. You can complete the assignments at your
create a workbook solely focused on practical applications to own pace based on your needs and interests.
promote positive body image that is grounded in research
findings along with clinical insights. Unique Features of Our Workbook
We recognize that communication challenges exist Our workbook offers these unique features in one source:
between researchers and clinicians who specialize in positive • Accessibility. An easy-to-use resource for clinicians, clients,
body image. We believe that researchers benefit from the and general readers who would like to know more about
clinical expertise of clinicians specializing in this area and positive body image and/or wish to improve their body
that clinicians benefit from integrating research findings into image.
clinical practice. As both researchers and clinicians ourselves, • Introspection. Preparation chapters for clients/readers
we have created this workbook with the goal of increasing (Chapter 2) and clinicians (Chapter 3) to increase self-
communication within the profession as well as making the awareness. Both of these chapters offer common
information available to the general public. For this particular questions and answers on how to move toward positive
workbook, Tracy drafted the “Theory and Research” sections, body image. For clients/readers, the chapter addresses
and Nichole and Casey drafted the clinical tools (“Talking topics such as motivation, values, strengths, purpose,
Points”, “Treatment Goals and Objectives”, “Applications”, goals, and more. For clinicians, the chapter focuses on
and “Assignments”). how to prepare both professionally and personally for
For the researcher: We integrate up-to-date research on this work. Assignments specially created for clinicians
positive body image topics from peer-reviewed journals are included.
and academic sources in the “Theory and Research” sec-
• Education. Nineteen chapters provide information on
tions. We reference each original source for additional
different components of positive body image such as
reading. We also offer valid and reliable assessments
embodiment, body appreciation, self-care, intuitive eating,
along with instructions on how to interpret them and
social comparison, body talk, and more.
apply them within a real-world context for each of the
• Intervention. Treatment planning tools, including “Talking
body image topics.
Points” along with treatment plan goals and objectives, are
For the clinician: We review relevant information
included in each chapter to promote effective clinical
about components of positive body image in an easy-to-
interventions.
read format that you can then share with your clients.
• Assessment. Twenty-one reliable and valid assessments with
The “Treatment Planning” sections offer specific talking
guidelines for interpretation and applications accompany
points that you can include in your sessions as well as
each body image topic.
goals/objectives that you can tailor for treatment plans.
2
Unique Features of Our Workbook
3
Introduction to the Positive Body Image Workbook
4
Applicability and Limitations
• We promote “body acceptance” throughout the workbook order to promote the client’s sense of personal choice,
while acknowledging that this experience may not be fully validation, and empowerment throughout this process.
relatable for all. For example, those who identify as
transgender may choose various forms of transition in order
to promote congruence with their gender expression(s) and Be the Change!
ultimately body acceptance. We encourage future research As mentioned in our guiding beliefs, we believe that change
endeavors to focus specifically on positive body image in is necessary at numerous levels to lower the incidence of
transgender and gender nonconforming individuals in order body image issues and to simultaneously promote positive
to fully appreciate and honor these experiences. body image. This workbook specifically targets change at the
• We mindfully refrained from integrating trauma-focused individual level by teaching skills to recognize and resist
content in the workbook. This decision was based on the harmful body-related messages while also promoting self-
collective philosophy that trauma-focused issues are most acceptance. Individuals can then create a rippling effect of
appropriately addressed within a therapeutic context, in change by inspiring loved ones, friends, community mem-
which the client’s unique needs and experiences are bers, and others to move toward positive body image.
honored. Trauma-focused therapy necessitates assessment Ultimately this change can permeate at a societal level. For
by a trained clinician to determine the appropriate stage example, individuals who apply the skills from this work-
of trauma work and to offer a recommended treatment book can get others involved by discussing the harms of
modality based on the client’s unique trauma history and weight stigma and the benefits of body acceptance, mentor
treatment goals. It is important to note that those with others to have a positive body image, boycott companies
histories of trauma may experience additional concerns that perpetuate weight stigma, and engage in social action in
related to their bodies such as self-protection, intimacy, many other ways.
body awareness, body trust, and body control. We We envision a collective effort of challenging appearance
encourage clinicians and clients to tailor the treatment ideals and combating weight stigma; a movement toward
tools, assessments, applications, and assignments within what really matters. We, the authors, commit to promoting
this workbook as clinically indicated to best fit the body acceptance within society, and we hope to inspire you
experiences of the client. Additionally, we recommend (clinicians, clients, and readers) to join us in this mission.
discretion when selecting workbook interventions in We are excited that you are taking this step with us!
6
Chapter
Client and Reader Preparation
2
Welcome! practice. Additionally, it involves approaching uncomfortable
So you’ve decided that you want to address your body image emotions and thoughts along with behavioral changes.
issues with the goal of moving toward positive body image – Remember that you have a choice; you can choose to do noth-
good for you! It’s likely that you have had some concerns for ing, keep doing things in the same way, or do things differently.
a while and are now trying to figure out how to make positive Simply wishing or thinking about things will not result in
changes. Maybe you’ve tried different strategies to improve body change. There are pros and cons associated with working on
acceptance; some worked, some didn’t. Whatever your journey these issues versus not working on them at different points in
has been to date, we welcome you to our approach on how to your life. Complete Assignment 2.1 “Pros/Cons of Working on
embrace positive body image. Body Image Issues” to identify costs and benefits of changing
Some quick information about how this workbook is
versus keeping things the same.
structured.1 Each content chapter (Chapters 4–22) includes the
Even after you have decided that you want to make changes,
following sections:
it can be challenging because motivation naturally waxes and
• “Theory and Research” – information from experts about wanes. Some days you might feel inspired and other days you
a body image topic;
might wonder whether the work is worth it. It’s normal to feel
• “Treatment Planning” (“Talking Points”, “Goals”, stuck and overwhelmed. During those times, it can be helpful to
“Objectives”) – suggestions on topics to discuss with others;
refer back to your original reason(s) for wanting to make
sample goals and objectives for your journey;
change. Complete Assignment 2.2 “Preparing for Positive
• “Additional Resources” – recommendations for additional
Body Image Work” which focuses on the reason(s) why you
information;
want to make change, desired outcomes, what coping skills you
• “Assessments” with “Applications” – assessments related to body
can use during this process, and sources of support.
image that you can complete along with questions for
reflection; Upon responding to these questions, if you notice that your
ultimate focus is to change your body (e.g., lose weight, cos-
• “Assignments” – different types of activities to apply and
deepen information on body image. You can choose which metic surgery), then this workbook might not best fit your
ones to complete and which ones to share with important goals. If you notice that your ultimate focus is to change your
others (e.g., family, friends, partners). mindset about your body, then this workbook will help you on
your journey.
In this chapter, we offer frequently asked questions and What has impacted my current body image? Before any
answers about positive body image. We encourage you to read
change toward positive body image can take place, it’s
this chapter and complete the corresponding assignments before
moving on to the following chapters. These assignments will important to determine what your body image is currently
serve as a foundation for your work toward positive body like and the life experiences that have shaped it. Many
image and remind you of your reasons for this work. factors influence body image over time, such as comments
So let’s get started! Remember to be persistent, patient, and from family members, exposure to messages in media, body-
compassionate with yourself during this process. related changes with age, and more. These experiences can
be interpreted as negative, neutral, or positive and corre-
Warmly,
spond with different emotions, thoughts, stories, and beha-
Nichole, Tracy, and Casey
viors. Assignment 2.3 “Body Image across Lifespan” offers
suggestions on how to create a visual representation of your
What is the problem with my body image? It is helpful to identify
unique body image experiences over time and how they
the specific problem(s) related to your body image. Take
impact your current functioning. As you review these
a moment to clearly define the current problem(s) in one sentence:
experiences, you’ll notice:
__________________________________________________
__________________________________________________ • the emotions that can range from sadness, shame, anger, and
embarrassment to pride, satisfaction, and joy;
What can I do to prepare myself for body image work? Body • the thoughts and stories you believe(d) about yourself then
image work requires time and effort along with consistent and now related to these experiences;
1
A detailed description of the workbook can be found in Table 1.1: “Workbook Overview” in Chapter 1.
7
Client and Reader Preparation
• the behaviors from trying to change your body, avoiding weight bias (judging ourselves or others negatively based on
uncomfortable experiences, altering your appearance, trying weight) is part of these reasons. Research shows that weight
new activities, and promoting positive change in others; stigma actually reinforces negative body image [4]. It is helpful
• how body investment (how much time or focus you spend on to shift the focus from weight loss to challenging internalized
your body) and body evaluation (how you judge your body) weight bias. Chapter 5 explains weight stigma and internalized
change at different points; weight bias in depth.
• how specific feedback and comments from others such as Moving toward positive body image is about internal
family members, friends, partners, medical professionals, acceptance versus changing external appearance. Our
coaches, teachers, mentors, community leaders, approach focuses on treating the mind and body with respect,
acquaintances, and even strangers impact your experience such as getting consistent nourishment, engaging in life-
with your body. enhancing movement, and fostering self-acceptance. The
body will respond in whatever ways it needs to.
What is important to me? As part of this journey, it is What will it take to change my body image from negative
important to consider your core values which serve as guide- to positive? Simply wishing or hoping for things to change will
posts in life. Values offer a point of focus and direction for likely not result in that outcome. Committed action, or the
moving out of a stuck place [1]. Examples of core values process of making small steps toward change [5], is necessary.
include justice, equality, freedom, love, compassion, service, Keeping your values, character strengths, and purpose in mind
intellect, success, respect, appreciation of beauty, humor, artis- is part of committed action. Each small step should be in the
tic expression, achievement, and financial security. Core values direction of your values. When engaging in committed action
can change throughout life depending on circumstances and remember to choose behaviors that aren’t too easy and not too
experiences. Complete Assignment 2.4 “Core Values” to iden- challenging; choose those that are just right. Take small steps
tify your top five core values and examine the degree to which that are challenging but not impossible, in order to build
behaviors in your life are currently aligned with your core a sense of accomplishment and to motivate for additional
values. action. Complete Assignment 2.8 “Committed Action toward
As unique individuals, we all have different combinations Positive Body Image”.
of character strengths [2]. Examples of these character It is helpful to recognize how engaging in certain behaviors
strengths include bravery, teamwork, forgiveness, curiosity, prevents you from moving toward positive body image.
zest, and perseverance. Check out the VIA Institute on Examples of such behaviors include excessive body checking
Character to learn more about character strengths and to or weighing, dieting, purging (e.g., self-induced vomiting, use
complete a free online scientific survey to determine your of laxatives or diet pills to control weight), excessive exercise,
top strengths. Consider how your “Character Strengths” self-injurious behaviors, consistent substance use, and more.
(Assignment 2.5) relate to your body image. Complete Assignment 2.9 “Behaviors that Move Me Toward or
Values and character strengths correspond with our sense Away from Positive Body Image”. This assignment can help
of purpose. Purpose is our reason for moving forward when you identify what behaviors move you further from or closer to
times are difficult. It is what energizes and inspires us to create positive body image (e.g., eating when hungry, stopping when
change for ourselves and sometimes others. Reflect on your full, being around others who accept your body, engaging in
unique “Purpose in Life” in Assignment 2.6 with special con- life-enhancing movement), and make specific goals to increase
sideration of how it relates to moving toward positive body these behaviors.
image. Additionally, respecting and protecting your body from
What are my body image goals? It is important to identify potential threats and harm corresponds with moving toward
goals related to positive body image as they lead us in a desired positive body image [6]. Examples of these protective behav-
direction towards our values. Goals can range from short-term iors can be asserting your needs, using sunblock, taking med-
to long-term. Try to be specific about what you want versus ications as needed, and getting vaccines. Review “Protection of
what you don’t want. Imagine having achieved your goal(s), the Body” (Assignment 2.10) to identify ways that you are
including associated emotions, thoughts, and behaviors. currently caring for your body and to learn additional ideas
Complete Assignment 2.7 “Body Image Goals”. of how to do so.
What if my goal is to change my body including lose Your mental perspective also impacts the transition from
weight? Research shows that weight loss is not effective long- negative to positive body image. If you notice that your
term; most people gain back the weight they lost and more [3]. thoughts are negative or pessimistic, try to be open to new
Examine your various intentions or reasons for wanting to lose ways of viewing yourself and your body without judgment.
weight. Examples might include not liking your current shape/ Practice replacing negative thoughts with positive thoughts.
size/weight, wanting to fit into certain types/size of clothing, Complete Assignments 2.11 “Practicing Body Acceptance” and
being instructed by your medical provider to do so for health 2.12 “Self-Affirmations”.
reasons, receiving negative appearance-based feedback from What challenges might get in the way of moving toward
a partner, or believing that weight loss will increase your positive body image? It is helpful to identify and anticipate
positive body image or overall quality of life. Upon identifying barriers associated with change so that you can problem solve
the reasons, it is helpful to consider whether internalized in advance. Complete Assignment 2.13 “Barriers and
8
Client and Reader Preparation
Solutions” to know how you would like to respond if and when body image but it might not ever be “finalized” because the
various challenges come your way. body and mind are constantly changing. Your specific
How can I track my realizations as I progress through this definition of positive body image might change or evolve
work? It is helpful to identify one or more key points you would over time based on different factors in your life, and that’s
like to take from each chapter (Chapters 4–22) using Assignment okay.
2.14 “My ‘Take-Home’ Realizations”. You can also record your Having identified your core values, character strengths,
overall realizations as you move toward positive body image. sense of purpose, goals, and willingness to participate in com-
How will I know once I’ve achieved positive body mitted action, you’re ready to begin your journey!
image? Realize that you’re always moving toward positive
9
Client and Reader Preparation
Pros Cons
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
10
Assignment 2.2: Preparing for Positive Body Image Work
• What’s the purpose for moving toward positive body image at this time in my life?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
• How much of this is driven by my wants/needs? By the wants/needs of others (e.g., partner, family, friends)?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
• How can I tolerate the uncomfortable thoughts and emotions that might come up while moving toward positive body image?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
11
Client and Reader Preparation
Be creative with the timeline, using whatever materials you prefer. For example, you can use a pen to make a timeline on paper,
create a collage with different images, review important photographs at different times in your life, create artistic pieces, and more.
• What factors contribute(d) to my body investment (how much time or focus is spent on the body)? Examples might include
puberty, body changes, influence of others, life experiences, the aging process, loss of functioning, and more.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
• What factors contribute(d) to my body evaluation (how the body is judged)? Examples might include puberty, body changes,
influence of others, life experiences, the aging process, loss of functioning, and more.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Negative Experiences
• What emotions correspond with these experiences?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
12
Assignment 2.3: Body Image across Lifespan
Positive Experiences
• What emotions correspond with these experiences?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Neutral Experiences
• What emotions correspond with these experiences?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Overall Reflections
• Does thinking about past events impact my ability to move toward positive body image?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
• Does thinking about future events impact my ability to move toward positive body image?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
13
Client and Reader Preparation
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
• My overall reflections:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
14
Assignment 2.4: Core Values
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
2
www.thegoodproject.org/value-sort
15
Client and Reader Preparation
What differences are there between my character strengths and my body image?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How can I rely on my character strengths when I’m feeling overwhelmed with body image work?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How can I enhance my current strengths as I work toward improving my positive body image?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How can I enhance other personality traits that are not my strengths as I work toward positive body image?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How can I turn my focus to my character strengths when I am thinking about perceived limitations or weaknesses about my body?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
3
www.viacharacter.org/
4
www.viacharacter.org/survey/account/register. For a list of the twenty-four character strengths, see www.viacharacter.org/character-strengths.
16
Assignment 2.6: Purpose in Life
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
17
Client and Reader Preparation
• What do I want?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
• What do I imagine positive body image to be like? How would I think differently? How would I experience emotions differently?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
18
Assignment 2.8: Committed Action toward Positive Body Image
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
19
Client and Reader Preparation
Assignment 2.9: Behaviors that Move Me Toward or Away from Positive Body Image
You will learn how some behaviors move you closer toward a positive body image and how other behaviors move you further from
it. Listed below are examples of different types of behaviors that can correspond with body image. First, indicate whether the
behavior applies to you by circling either yes or no. Second, make a mark on the continuum where each behavior exists from
moving toward positive body image (e.g., acceptance, appreciation, gratitude) versus moving away from it (e.g., distress, sense of
obligation, worries). Record reflections including how these behaviors impact your progress toward positive body image. An
example is provided. Additionally, it may be helpful to return to this assignment upon completing Chapters 4–22 to determine
whether any of your responses have changed.
Example:
Dieting: Yes or No
I––––––––––––––––––––––––––––––––––––––––––X––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––I
Away Positive Body Image Toward
Reflections: I diet in order to feel better about myself. I want to lose weight so that I can look better and feel better. I notice that when I’m dieting,
I say mean things to myself and am grouchy with others.
Dieting: Yes or No
I––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––I
Away Positive Body Image Toward
Reflections:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide. 21
Cambridge: Cambridge University Press, 2021.
Client and Reader Preparation
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement
Guide. Cambridge: Cambridge University Press, 2021.
22
Assignment 2.10: Protection of the Body
Level of relevance:
0 = not at all to Action plan for
Issue 10 = very Reflections change(s)
Example: Preventative health behaviors (e.g., 5 I know it’s important to do these I’ll set a reminder in my
breast/prostate exams) things, but I don’t have the time. calendar to do this.
I probably should do it considering
my family history of cancer.
Asserting my needs
Getting vaccines
Communicating desires
Use of contraception
Taking medications/
supplements
Use of sunblock
Other:
Other:
Other:
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
23
Client and Reader Preparation
These are the unique physical contributions from my family members and ancestors:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
I commit to saying the following body acceptance comments on a daily basis (examples: “I accept my body as it is,” “I appreciate
that my body can function in these ways”):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
24
Assignment 2.12: Self-Affirmations
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
25
Client and Reader Preparation
❏ Uncomfortable emotions – fear, anxiety, shame, disgust, embarrassment, despair, being overwhelmed:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
❏ Negative beliefs – “I can’t do this,” “things will never change,” “things have never worked in the past, why would they now?”:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
26
Assignment 2.13: Barriers and Solutions
❏ Other:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
❏ Other:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
❏ Other:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
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Client and Reader Preparation
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
28
Assignment 2.14: My “Take-Home” Realizations
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide. 29
Cambridge: Cambridge University Press, 2021.
Client and Reader Preparation
Overall realizations:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
N. L. Wood-Barcalow, T. L. Tylka, and C. L. Judge. Positive Body Image Workbook: A Clinical and Self-Improvement Guide.
Cambridge: Cambridge University Press, 2021.
30
Assignment 2.14: My “Take-Home” Realizations
References
1. S. C. Hayes, K. D. Strosahl, to obesity and to the metabolic (2nd ed.). New York: Guilford Press,
and K. G. Wilson. Acceptance syndrome: An overview. Obes Rev 2015; 2012.
and Commitment Therapy: The 16: 1–6.
6. N. L. Wood-Barcalow, T. L. Tylka, and
Process and Practice of Mindful Change 4. L. R. Vartanian and J. G. Shaprow. C. L. Augustus-Horvath. “But I like my
(2nd ed.). New York: Guilford Press, Effects of weight stigma on exercise body”: Positive body image
2012. motivation and behavior: A preliminary characteristics and a holistic model for
2. VIA Institute on Character. The VIA investigation among college-aged young-adult women. Body Image 2010;
Character Strengths Survey: Your females. J Health Psychol 2008; 7: 106–16.
Greatest Strengths Lie Within. Retrieved 13: 131–8.
7. S. C. Hayes, K. D. Strosahl, and
from www.viacharacter.org/account/ 5. S. C. Hayes, K. D. Strosahl, and K. G. Wilson. Acceptance and
register K. G. Wilson. Acceptance and Commitment Therapy: The Process
3. A. G. Dulloo and J.-P. Montani. Commitment Therapy: The Process and Practice of Mindful Change (2nd
Pathways from dieting to weight regain, and Practice of Mindful Change ed.). New York: Guilford Press, 2012.
31
Chapter
Clinician Preparation
3
We have been asked by clinicians over the years how to best Why specialize in this area? As mentioned previously, it is
help individuals with body image issues. Just as it is important common for individuals to have experienced body image con-
for clients and readers to educate themselves about positive cerns during the course of their lives. Negative body image can
body image, it is also important that clinicians: (a) know how to result in medical complications from unhealthy behaviors,
help clients in meaningful and effective ways, and (b) have an impaired social relations, poor quality of life, and more.
awareness and understanding of their own body image experi- Additionally, there are too few clinicians who have received
ences. We offer frequently asked questions and answers about training and education on how to promote positive body image
clinical interventions for positive body image. Additionally, we in a way that is informed by theory and research.
offer assignments specifically designed for clinicians to pro- How can this workbook be relevant for clients of various
mote increased self-awareness.1 backgrounds and experiences? We include research articles
Do I need to know this information if I don’t provide direct that include diverse samples in terms of social identities
clinical care? The information contained in this workbook is (e.g., gender, race, age, gender identity, sexual orientation,
applicable to clinicians in a variety of clinical settings (e.g., geographic location, and more). Also, we considered clients’
medical services, mental health counseling, dietary services). social identities and experiences as we designed treatment
Additionally, this information is applicable to teachers, educa- planning tools, assessments, and assignments. The resources
tors, coaches, physical/personal trainers, and more. You are we provide also take into consideration various social iden-
likely already interacting with individuals with body image tities and experiences.
issues in personal relationships or community settings as no How can I confidently and competently address medical
person or group is immune to body image pressures. and nutrition issues related to body image disturbance if I’m
Where can I find information about positive body image to not a physician or dietitian? It can be challenging to know fact
increase my knowledge and skills? This workbook synthesizes up- from fiction related to medical and nutrition information due
to-date information about positive body image from researchers to how it can be distorted or portrayed. As a result, you might
and clinical experts around the world (Chapters 4–22, in particu- have difficulty challenging a client’s distorted beliefs without
lar). Read the following scholarly books: Body Image: A Handbook solid factual information. It is essential to have frequent con-
of Science, Practice, and Prevention [1]; Body Positive: sultation with medical and dietary colleagues to address the
Understanding and Improving Body Image in Science and actual science behind the social trends in order to provide
Practice [2]; and the Handbook of Positive Body Image and effective and appropriate clinical interventions. Consider how
Embodiment: Constructs, Protective Factors, and Interventions you can establish a consultation network of reputable clini-
[3]. Review the latest research via peer-reviewed articles in Body cians. In particular, we recommend medical and dietary collea-
Image: An International Journal of Research. Join organizations gues who practice from a weight-inclusive approach (see
that promote positive body image such as The Body Positive and Chapter 5) to reduce the likelihood of weight stigma influen-
the Health at Every Size (HAES). Learn clinical techniques by cing the medical and nutrition information provided.
watching webinars from skilled practitioners. Connect with clin- Why do some people with body image issues engage in
icians from various disciplines in your community to learn how behaviors that are destructive or harmful? Individuals with
they address body image issues. Create a network of trusted body image disturbance will often try to change their bodies
colleagues with whom you can consult. Keep up with sociocul- using different behaviors that range from relatively benign to
tural trends regarding body image topics, as these trends will extreme (e.g., exercise, dietary restriction, self-induced vomit-
likely emerge in clinical encounters. Finally, remember that cli- ing, cosmetic surgery) in order to feel better about their bodies.
ents are a source of knowledge and expertise as well. What you They typically view the behaviors as helpful and constructive
learn when interacting with one client may be helpful with and experience fear in the thought of relinquishing them. As
another. a clinician, it is important to recognize that these behaviors are
Do I have to be an expert on positive body image in order to rooted in ingrained beliefs and strong emotions, and they serve
provide services/care? You don’t have to master all of this various purposes or functions. Having this awareness will help
information to be a competent provider. you to decrease judgment and cultivate compassion, both of
1
A detailed description of the workbook can be found in Table 1.1: “How to Use This Workbook” in Chapter 1.
32
Clinician Preparation
which are integral components of providing care to those with assessments in clinical work include difficulty finding valid
body image issues. and reliable assessments, challenges in seeking permission
Is it helpful for me as a clinician to ignore, minimize, or from authors to use the assessments, and lack of awareness of
dismiss body image disturbance to reduce the impact of it? It is how to incorporate assessments in an effective manner. We
common for individuals with body image disturbance to offer an array of reliable and valid body image assessments
experience significant anguish and despair. This pain is real along with corresponding applications (suggestions for discus-
and legitimate. Ignoring, minimizing, or dismissing a client’s sion) in the text to assist in streamlining treatment focus.
experience is neither helpful nor effective. Rather, it is helpful How can I communicate effectively about this complex
to validate the body image distress and acknowledge the issue? What if I say the wrong thing? As with any sensitive
impact on the client’s quality of life. A reduction in body topic, we encourage you to be open, honest, humble, respectful,
image disturbance typically occurs when an individual and curious. Recognize that you will make mistakes, say the
addresses the issue directly with the use of effective coping wrong thing, and might unintentionally offend a client, just as
skills. we have over the years. Don’t allow this fear to prevent you
The way that clients see themselves can be vastly different from providing care or having important conversations that
from the reality. Is it helpful to try to convince clients to see could be beneficial to your clients. If any of these challenges
how beautiful they are? Trying to convince someone to recog- occur, take accountability, make a repair, and move on. We
nize their own beauty can be a challenging and often futile offer sample language to use during your interactions with
endeavor, resulting in frustration for both individuals. clients in Assignment 3.1 “Ways to Dialogue with Clients
Intellectual reasoning alone often does not resolve this issue about Sensitive Topics”.
due to the complexity of thoughts and emotions associated How can my own worldview and beliefs impact caring for
with body image. It can be helpful to validate the client’s clients? Your training, education, social identities, and life
discomfort while simultaneously offering hope through learn- experiences shape how you view the world and your clients.
ing new coping skills to work through moments of body image It can be helpful to recognize potential biases related to shape,
distress. weight, and size. Explore how your own worldview interfaces
Is it okay to comment on a client’s body to let them know with those of your clients in Assignment 3.2 “Personal
that they don’t look bad? It is important that you refrain from Viewpoints that Shape Clinical Responses”.
commenting on your client’s appearance in general. Even What if a client judges me based on my appearance? It’s
offering perceived “positive” comments can be misconstrued important to accept the reality that all people judge and are
by the client and potentially lead to undesirable outcomes such judged based on appearance. As clinicians, we too are judged
as a heightened focus on their appearance and a rupture in based on our appearance such as our age, gender identification,
your clinical relationship. Rather than comment on their height, weight, hairstyle, skin color, clothing, grooming, jew-
appearance, you can redirect focus to their emotions, cogni- elry, and more. These appearance-based judgments by our
tions, and behaviors. clients can impact how they perceive our knowledge, expertise,
In my field and training, I’ve been taught that inducing and even our ability to understand their experiences. When it is
some guilt or shame in clients can serve as positive motivation clinically relevant and beneficial, there can be honest and direct
for change. Is this effective? Shame and guilt do not lead to dialogue between clinicians and clients about client assump-
positive change, and in fact, often create additional distress, tions, impressions, and comparisons.
secrecy, and avoidance. You can inform clients that shaming What if a client comments on my appearance? The reality
themselves is not helpful. What is helpful is to focus on self- is that a client will make appearance-based comments about
compassion and self-acceptance instead, which correspond you that you will perceive on a range from positive to negative.
with hope, inspiration, and motivation. When a comment is made, it is helpful to maintain a neutral
When a client wants to lose weight to feel better about stance and respond in a way that is focused on the client, not
themselves, is it okay if I endorse or recommend it? Do not you. It can be beneficial to have stock phrases available in
recommend or praise weight loss efforts, as it does not corre- advance. Review Assignment 3.3 “How to Respond upon
spond with improved body image. Instead, you can educate on Receiving an Appearance-Based Comment from a Client” to
how appearance and weight bias are prevalent within society, consider what responses you might utilize in your client
which reinforces body image disturbance. You can inform how interactions.
positive body image is about internal acceptance versus chan- What if I’m struggling with or have struggled with my own
ging external appearance. You can encourage clients to engage body image issues? Good for you for being aware of and honest
in nurturing behaviors such as consistent nourishment, life- about your experiences. You don’t have to fully or completely
enhancing movement, and other types of self-care practices embrace your own positive body image to offer assistance with
that are promoted in this workbook. The body will respond in those moving toward it, and it is important to be aware of how
whatever ways it needs to. your relationship with your own body can impact your clinical
How do I know what to focus on in treatment? In addition interventions. Explore how your “Own Body Image
to asking questions of your clients, it’s also helpful to use body Experiences” (Assignment 3.4) can impact your clinical work
image assessments to determine your client’s unique body with clients. You may also find it beneficial to read and com-
image concerns. Common barriers for not including plete information in the content chapters (assessments,
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Clinician Preparation
applications and assignments) to continue your own journey a broader context, you can advocate by speaking up about
towards a positive body image. these topics with colleagues, educating community members
If you are unsure of whether to address your own body about weight stigma, and challenging policies that interfere
image issues at this time, you can complete Assignment 3.5 with positive body image development. Additional advocacy
“Pros/Cons of Working on My Own Body Image Issues” to examples are offered in Assignment 3.6 “Advocating for
help guide your decision. It is helpful to know your own Positive Body Image”. Check which advocacy actions you
strengths and challenges associated with body image issues to are already engaged in and consider what ones you would
assist in your own work. like to pursue.
How can I advocate for clients? In the clinical setting, Having reviewed common questions about how to best help
you can teach clients about complex sociocultural factors clients and understand your own body image experiences,
that promote negative body image and empower them to you’re ready to complete the following assignments to prepare
make positive changes along with committed action. In you for this valuable work!
34
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there was scant breath for speech in the long climb; and for this
Brant was thankful. The scene in Gaynard’s was yet fresh in mind
and heart, and not even to the friend of his youth could he trust
himself to speak freely.
The moon was rising when they reached the summit of the pass, and
Hobart pointed down the farther slope to a dark mass hugging the
steep mountain side.
“That is the Hoopoee shaft house,” he said. “The railroad is just
below it. Got matches and cigars?”
“Yes, both.”
“Then I’ll go back from here. Good-bye, old fellow, and God bless
you! Tie your courage in a hard knot, and let me hear from you.”
Brant grasped his friend’s hand and wrung it in silence. He tried to
speak, but the words tripped each other.
“Never mind,” Hobart broke in. “I know what you want to say, and
can’t. It is nothing more than you would have done if the saddle had
been on the other horse. And about your—the woman: I’ll do
whatever you could do, if you stayed. Now, then, down you go, or
you’ll miss your train. Good-bye.”
CHAPTER II
THE VINTAGE OF ABI-EZER
Having set himself to expiate his fault, Brant wore out the day in the
smoking compartment in comfortless solitude, doing penance by
limiting himself to one cigar an hour. It was dull work, but not
altogether profitless. For one thing there was plenty of time to think;
and for another the expiatory mill had a chance to grind out a goodly
grist of conclusions. The first of these was that there were going to
be more obstacles in the way to amendment than those interposed
by an uncharitable world; that apart from the sharp fight on the firing
line, he was likely to have trouble with an insubordinate garrison.
Now a fine scorn of obstacles was another of the lessons learned in
the hard school of abandonment, and Brant set his teeth on a
doughty resolution to override them in the race for retrieval, as he
had overridden them in the mad gallop pitward. Self-respect, or
some comforting measure of it, should be regained though the devil
himself held the present reversion of it. There should yet come a
day, please God, when he would not be constrained in common
decency to put the length of a Pullman car between himself and a
good woman. Moreover, the past should henceforth be a dead past,
and woe betide the enemy, man or devil, who should have the
temerity to resurrect it.
The gage of battle thus thrown to the powers of darkness was
promptly taken up. After one of the many stops with the troublesome
axle the rear brakeman came into the smoking compartment and sat
down, as one weary. To begin at once the shedding of the churl shell
of the master gambler, Brant nodded pleasantly; whereupon the
brakeman passed the time of day and immediately began,
railwaywise, to abuse his calling and to ease his mind in respect of
the hot box.
“She never has made a run yet without keeping everybody on the
keen jump,” he declared. “By gum! I’ve been chasing up and down
with the dope kettle ever since one o’clock this morning.”
“She?” said Brant, to whom railway speech was an unknown tongue.
“Yes; this here car—the Hesp’rus. Last time we had her it was the
back box on this end; now it’s the for’ard one under the drawing-
room—blazing away like a blooming track torch more’n half the
time.”
“Keeps you busy, does it?”
“You’re mighty right it does. And when I have a job like this, I like to
have some blame’ fool pilgrim come up and begin to jaw about the
soft snap a brakeman has now they have the air brakes.”
“Did somebody do that?”
“Sure; first thing this morning. Big chap in a linen duster and smoking
cap; same one that—” The brakeman stopped short, as one who
suddenly finds himself treading upon what may prove to be
dangerous ground.
“Go on,” said Brant encouragingly.
“Well, I mean the fellow you had the scrap with. Great Moses! but he
was hot!”
“Was he? So was I.”
“You’d better believe he was. Came out of that dining room rearin’
like a buckin’ bronco; said he was going to have the law on you, and
wanted the old man to wire ahead for a policeman to meet the train.”
“What old man—the conductor?”
“Yes; and Harker told him he couldn’t do it, because the row didn’t
happen on the train; said he didn’t know who you was, anyway. Then
I chipped in, and told ’em you was Plucky George, the man that
cleaned out the six toughs when they tried to run the bank up at
Silverette. Holy Smoke! but you ought to’ve seen old linen duster fall
apart when I said that!” The brakeman laughed joyously, but Brant
groaned in spirit at this ominous hint that his reputation meant to
keep pace with him.
“You’d better believe he was rattled right!” the man went on. “He just
went yaller, and the last I saw of him he was up ahead, looking for
you so’t he could apologize. Ain’t that rich?”
“Very rich,” said Brant grimly. Then he saw his advantage and made
good use of it. “In fact, it is much too rich to spoil. Go find the fellow
and tell him I’m in a bad humour, but that he is safe as long as he
keeps away from me. Will you do that?”
“Sure,” assented the brakeman, getting upon his feet. “I’ll do better
than that: I’ll scare him till he won’t get a good breath this side o’ the
Missouri River.”
Brant’s eyes narrowed, and in the turning of a leaf the mantle of
humility slipped from him and he became Brant the man-queller.
“You will do nothing of the sort. You will tell him just what I say, and
no word more or less. Now go.”
The man of dope kettles and rear-end signals was no coward, but
neither was he minded to pick a quarrel with the hero of a dozen
savage battles. Brant let him get to the door and then called him
back:
“Where does your run end?”
“Voltamo; next stop but one.”
“Then you don’t go into Denver?”
“No.”
“But some time you may. In that case, it will be as well for you to
forget what little you may happen to know about me. Do you
understand?”
“You’d better believe I do. I can hold my jaw with anybody when I
have to; and I don’t have to be hit with a club neither.”
“Good. Have a cigar—and don’t forget what I say.”
The brakeman took the proffered cigar and vanished; and thereupon
Brant began to repent once more and to grope for the lost mantle of
humility. Here on the very heels of his good resolutions he had
balked at one of the smallest of the obstacles, bullying a man in his
displeasure and trading upon his reputation as a man-queller like
any desperado of the camps. It was humiliating, but it proved the
wisdom of the smoking-room exile. Truly, he was far enough from
being a fitting companion for the young woman in Section Six.
As he had predicted, the train lost time steadily throughout the day,
and an early supper was served at the regular dinner station. Brant
went to the dining room with the other passengers, and when Miss
Langford did not appear, he sent the porter to her with a luncheon
and a cup of tea.
“It is about what I had a right to expect,” he told himself when he was
once more back in the solitude of the smoke den. “She was afraid to
trust herself in the same dining room with me. Why the devil couldn’t
I have held my cursed temper just ten seconds longer? Here I’ve had
to sit all day and eat my heart out, when I might have been getting
miles away from the old life in her company. What a fool a man can
make of himself when he tries!”
“That is a fact,” said a voice from the opposite seat; and Brant, who
had been staring gloomily out of the window at the wall of blackness
slipping past the train, and so was unaware that he was not alone,
was unreasonable enough to be angry.
“What’s that you say?” he began wrathfully, turning upon his
commentator; but the pleasant face of the young man in the opposite
seat was of the kind which disarms wrath.
“It’s on me,” he laughed. “I beg your pardon. I spoke without thinking,
but what you said about the fool-making faculty calls for general
ratification. We all have it.”
Brant nodded, and the newcomer relighted his cigar, which had gone
out in the explanation. “Going in to Denver?” he asked, willing to let
interest atone for impudence.
“Yes.”
“Wish I were. I’ve been out a week now, and I’m beginning to long for
the fleshpots.”
“You have my sympathy if you have to stop overnight anywhere
between this and Denver,” said Brant, who knew the country.
“Luckily, I don’t have to. I am merely riding down to the meeting point
with Number Three to kill time. I have to go back to Voltamo to-
night.”
Brant laughed. “Do you find it cheaper to ride than to wait?”
“It is quite as cheap in my case; the railway company has to foot the
bills, anyway.”
“Oh—you are in the service, are you?”
“Yes.”
“Engineer corps?”
“No; operating department. I am chief clerk in the superintendent’s
office.”
They smoked companionably for a while, and then Brant said:
“Perhaps you can tell me some of the things I want to find out. Who
is your chief engineer now?”
“Colonel Bowran.”
“Good fellow?”
“Out of sight; gentleman of the old school, you know; West Point,
regular army, and all that. They say he won’t hire a chainman unless
he is a college graduate.”
“Is his office in Denver?”
“Yes; right next door to ours.”
“All of which is comforting,” said Brant. “I hope you will have me for a
neighbour. I am going to try for a billet on the C. E. & W.”
“Good!” exclaimed the chief clerk, rising at the sound of the
locomotive whistle. “My name’s Antrim, and you will find me in
Superintendent Craig’s office. Latchstring hangs on the outer wall.”
“And my name is Brant. Do you quit us here?”
“Got to do it—wish I hadn’t, now. Glad to have met you, I’m sure.
Don’t forget to hunt me up. Good night.”
They shook hands heartily at parting. It was Colorado, in the day
when strangers became friends—or enemies—on the spot; when
one unconsciously dropped the “Mr.” in an hour, and then slipped
easily around the surname to hobnob with Tom, Dick, or Harry in the
first interview.
For the exile the little chat with the chief clerk was heartening in its
way; and when the train was once more swaying and lurching along
its crooked course down the cañon he looked at his watch and
figured out the probable arriving time.
“Eleven hours late; that will make it ten o’clock in Denver. I wonder if
Miss Langford will find somebody to look after her when she gets in.
If she doesn’t——”
The interruption was the advent of the porter. The negro had been
trying to get speech with his patron for half an hour, but he was much
too discreet to deliver his message in Antrim’s presence.
“’Bout de supper, sah; de lady in lower Six say, T’ank you kin’ly, sah,
and would you-all be so kind and step back in de cyar a minute?”
“Certainly.” Brant rose to comply, but he was no sooner on his feet
than he was thrown violently all across the compartment.
“Golly Lawd! she’s on de ties!” gasped the negro, and the
exclamation ended in a yell of terror.
Brant kept his head, and thought only of the young woman alone in
the body of the car. With the floor heaving and bounding under him
like the deck of a storm-tossed ship, he darted out of the smoking-
room and flung himself against the swinging door in the narrow side
vestibule. It was jammed, but the glass of the upper panel fell in
fragments under his blow, and he was past the obstruction when the
end came. The heavy sleeper lurched first to the right, reeled
drunkenly for a critical instant on the brink of the embankment facing
the river, righted itself with a jerk when draw bars and safety chains
gave way, and then settled back to topple over against the cañon
wall, stopping with a crash that sent Brant to his knees just as he
was starting down the aisle.
The broken glass was still falling from the shattered deck lights when
he reached Section Six. The young woman was unhurt, but she was
very pale, and the gray eyes were full of terror.
“Don’t faint,” said Brant very gently, though he was wondering what
he should do in case she did. “It is all over now, I think.”
“But the others?” she faltered.
“Let us hope that the other cars have kept the track—that it is only
the ‘wreck of the Hesperus.’”
She smiled at the conceit, and asked what they should do.
“If you will promise not to faint while I am gone, I’ll go and find out.
There is no danger now.”
“I’m not going to faint; but please don’t be gone long.”
He was back in a moment, gathering up her belongings.
“There is nothing smashed but our car,” he explained. “They will
leave flagmen with it, and go on to Denver with the remainder of the
train. Will you take my arm?”
The wrecked sleeper was already surrounded by a throng of curious
passengers and anxious trainmen, and ready hands were extended
to help them down from the uptilted platform. But Brant put them all
aside, and lifted his companion to the ground as if the right were his
alone.
“It is all right, Mr. Harker,” he said, singling out the conductor. “I
mean, we are all out. There was no one else in the car except the
porter, and he isn’t hurt.”
They made their way through the throng of curious ones, and so on
down the track to the train. Brant found a seat in the day coach,
disposed his charge comfortably therein, and then, once more laying
hold of his courage, sat down beside her.
“I am not going to leave you again until I see you safe in Denver,” he
asserted; “that is, unless you send me away.”
“I didn’t send you away this morning,” she rejoined, with a smile that
went far toward making him forget for the moment who and what he
was.
“I know you didn’t; but you had a right to. And after what I had done,
there was nothing for it but to take myself off.”
She did not speak until the train was once more lurching on its way.
Then she said: “I thought at the time you were very patient; and—
and I think so still.”
“Do you, really? That is very good of you; but I think I don’t deserve
it. My first thought should have been for you, and I might have kept
my temper for another half minute.”
Now this young woman could rejoice in an excellent upbringing, as
will presently appear, and she knew perfectly well that Brant was
right. But where is the woman, old or young, who does not secretly
glory in a vigorous championship of her rights, even at the expense
of the proprieties?
So she spoke him fair, telling him that she was sending for him at the
moment of the accident to thank him and to pay him for her supper.
Nay, more: she made the next two hours so pleasant for him that
they were as but a watch in the night, and their flitting seemed to
push his life in the camps into a comfortably remote past.
And so they chatted amicably until the outlying lights of Denver
began to flash past the windows; and then Brant bethought him of
her further well-being.
“Will there be some one at the train to meet you?” he inquired.
“No; but my street-car line is only a block from the depot, and the car
takes me almost to our door.”
“I will put you on the car,” he said; and this he did some few minutes
later, bidding her “Good night,” and standing in the street to catch a
last glimpse of her as the car droned away to the northward. Then he
turned away to seek a hotel, and was well uptown before he
remembered that he had not thought to ask her address, or to ask if
he might call upon her.
“But that is all right,” he mused. “Denver isn’t London, and if I can
ever pull myself up into the ranks of the well-behaved, I shall find
her.”
CHAPTER IV
THE MIGRANTS