Welcome to the Positive Body Image Workbook! In this chapter, we offer an overview of positive body image, introduce ourselves and our work, share what inspired us to write this workbook, and describe how you may use it in your clinical practice (for cliniciansFootnote 1) and everyday lives (for clients and readersFootnote 2).
What is Positive Body Image?
This workbook focuses on increasing positive body image and reducing negative body image. Right now, you may be wondering, “Won’t reducing negative body image automatically improve positive body image?” In some ways, yes – but not in all ways. Negative body image includes negative feelings and thoughts about our appearance. Positive body image is broader than simply “positive feelings and thoughts about our appearance.” Positive body image includes appreciating our bodies in terms of how they function along with appearance. It means loving our bodies for their unique characteristics, which may change across time (e.g., “our scars are beautiful”). Holding a positive body image means that we perceive a wide range of appearances as beautiful, not just the bodies portrayed as attractive in social media, magazines, TV, movies, etc. Positive body image also includes how we “bounce back” from body image threats (or attacks on body image), such as negative comments made about our bodies. Positive body image can be expressed as taking care of our bodies (e.g., self-care), showing the world that we feel positively about and respect our bodies, and mentoring others to hold a positive body image as well. And, as you will see in this workbook, it is so much more.
Some people believe that it is unrealistic to have a positive body image. This skepticism is related to a narrow definition of positive body image: “loving every aspect of the body at all times” without experiencing discomfort or moments of negative body image. We agree that this outcome is unachievable when defined in this way, especially in cultures that value appearance ideals. Furthermore, we acknowledge that we all have moments in which our body image is not what we would like it to be. Our definition of positive body image, in contrast, includes loving and accepting our bodies regardless of appearance and functioning, showing compassion for differences and difficulties, and responding effectively when body image distress occurs. This definition is based on research studies (which we provide in this workbook) as well as our clinical experience of witnessing clients transform from negative to positive body image.
Who We Are and Our Guiding Beliefs
We are three colleagues and friends who have collaborated on published studies related to body image, intuitive eating, and disordered eating, and have provided services (including psychotherapy and trainings) focused on promoting positive body image. We share similar values (integrity, collaboration, and quality research and clinical work) and a passion to help all those who want to move toward positive body image. We believe that positive body image is attainable for any and all who are willing to commit and invest in it.
We each have our Ph.D. in counseling psychology, a discipline that focuses on individual strengths to help build resilience when faced with challenges while also promoting meaningful and fulfilling lives [Reference Gelso, Williams and Fretz1]. We draw from positive psychology, the scientific study of human strengths that help people thrive and cultivate what is best within themselves [Reference Lopez, Pedrotti and Snyder2]. Incorporating strength-based approaches into clinical treatment enhances outcomes beyond focusing solely on what is wrong [Reference Seligman, Rashid and Parks3]. Counseling psychologists honor multiple social identities (e.g., race, gender, class, age, weight, sexual orientation, gender identity, ability, etc.), explore how these social identities interact to shape experiences, and work to dismantle discrimination and stigmatization.
Our professional and personal identities shed light on the perspectives we bring to this workbook. We have had experiences with both privilege and disadvantage throughout our lives which shape our worldviews, and as a result, how we view body image work. We offer some of our guiding beliefs:
Positive body image is attainable for all persons of varying social identities.
It is important to focus on changing internal experiences of body image rather than external appearance. The problem with negative body image is not about the actual body itself but rather viewing oneself as deficient or unacceptable. As a result, we do not recommend weight loss goals for body image issues, given that weight and body mass index (BMI) are rather poor indicators of health [Reference Brooks, Black and Coster4–Reference Flegal, Kit and Orpana5]. Instead, we promote self-acceptance and compassion.
Biological issues and maladaptive behaviors (e.g., chronic dieting, self-induced vomiting, excessive exercise) need to be recognized and addressed in advance of body image work.
Negative body image is, in part, a byproduct of societies that idealize appearance and that treat individuals differently based on weight and body size, with higher-weight individuals often experiencing weight stigma. We advocate to reduce weight stigma (as well as other types of stigma) at various levels (e.g., societal, individual).
A weight-inclusive philosophy (supporting the well-being and health of people of all body sizes) is essential for moving toward positive body image.
Clinicians benefit from exploring how their own body image issues impact themselves and the clients with whom they work.
Self-care (e.g., consistent nourishment, life-enhancing movement) is the essence of moving toward positive body image and requires intentional effort and practice.
Inspiration, Vision, and Integration
The inspiration for this workbook emerged many years ago while Nichole contemplated how to share with fellow clinicians and clients alike her process of synthesizing research concepts about body image into clinical practice. The vision was to create a workbook solely focused on practical applications to promote positive body image that is grounded in research findings along with clinical insights.
We recognize that communication challenges exist between researchers and clinicians who specialize in positive body image. We believe that researchers benefit from the clinical expertise of clinicians specializing in this area and that clinicians benefit from integrating research findings into clinical practice. As both researchers and clinicians ourselves, we have created this workbook with the goal of increasing communication within the profession as well as making the information available to the general public. For this particular workbook, Tracy drafted the “Theory and Research” sections, and Nichole and Casey drafted the clinical tools (“Talking Points”, “Treatment Goals and Objectives”, “Applications”, and “Assignments”).
For the researcher: We integrate up-to-date research on positive body image topics from peer-reviewed journals and academic sources in the “Theory and Research” sections. We reference each original source for additional reading. We also offer valid and reliable assessments along with instructions on how to interpret them and apply them within a real-world context for each of the body image topics.
For the clinician: We review relevant information about components of positive body image in an easy-to-read format that you can then share with your clients. The “Treatment Planning” sections offer specific talking points that you can include in your sessions as well as goals/objectives that you can tailor for treatment plans. We include assessments along with instructions and applications for your clients to use at different points of treatment to gauge and demonstrate progress (e.g., clients can witness first-hand their objective change, substantiate gains to third party payors). We intentionally incorporated elements of various treatment modalities so that this workbook would be interesting and applicable to clinicians with different theoretical orientations: Cognitive Behavioral Therapy [Reference Beck6], Dialectical Behavior Therapy [Reference Linehan7], Acceptance and Commitment Therapy [Reference Hayes, Strosahl and Wilson8], Emotion-Focused Therapy [Reference Greenberg9], Compassion-Based Therapy [Reference Gilbert10], Interpersonal Therapy [Reference Weissman, Markowitz and Klerman11], Exposure Therapy [Reference Abramowitz, Deacon and Whiteside12], social justice [Reference Aldarando13], and Motivational Interviewing [Reference Miller and Rollnick14]. The assignments included in each chapter can be reviewed during sessions and/or offered as homework assignments to assist your clients in moving toward positive body image.
Of special note, we devote an entire chapter (Chapter 3 – “Clinician Preparation”) focused on how to help clients move toward positive body image within your clinical work. We also offer specific considerations and assignments for you as the clinician to promote introspection into how your personal experiences intersect with that of your clients.
For the client and general reader: We offer factual information about positive body image that is based on research and clinical expertise. You can complete the assignments at your own pace based on your needs and interests.
Unique Features of Our Workbook
Our workbook offers these unique features in one source:
Accessibility. An easy-to-use resource for clinicians, clients, and general readers who would like to know more about positive body image and/or wish to improve their body image.
Introspection. Preparation chapters for clients/readers (Chapter 2) and clinicians (Chapter 3) to increase self-awareness. Both of these chapters offer common questions and answers on how to move toward positive body image. For clients/readers, the chapter addresses topics such as motivation, values, strengths, purpose, goals, and more. For clinicians, the chapter focuses on how to prepare both professionally and personally for this work. Assignments specially created for clinicians are included.
Education. Nineteen chapters provide information on different components of positive body image such as embodiment, body appreciation, self-care, intuitive eating, social comparison, body talk, and more.
Intervention. Treatment planning tools, including “Talking Points” along with treatment plan goals and objectives, are included in each chapter to promote effective clinical interventions.
Assessment. Twenty-one reliable and valid assessments with guidelines for interpretation and applications accompany each body image topic.
Application. An array of assignments is offered with the purpose of applying and extending information on the body image topics. Readers can choose based on interest.
Sustainability. A final chapter is devoted to “intentional activities” to ensure that the progress achieved is thereby maintained.
How to Use This Workbook
Because the chapters are independent of each other, you can choose how to use this workbook: read it sequentially from beginning to end, pick chapters to read that are of particular interest, and/or any combination. We encourage clinicians to own a copy of the workbook to: (a) share general information about the different components of positive body image with clients during sessions, (b) make copies of chapters and assignments for clients to complete during the session or as homework, and (c) use for their own self-guided work on positive body image. We recommend that clients have their own copy of this workbook to serve as a useful companion to therapy.
In Table 1.1, we provide an overview of the various sections and components written from the perspective of the clinician, client in therapy, and general reader.
| Section | Portion | Clinicians | Clients | Readers |
|---|---|---|---|---|
| I. Introductory chapter (Chapter 1) and preparation guides (Chapters 2–3) | Chapter 3: Clinician Preparation is specifically designed for the clinician providing interventions for clients/group of clients with body image issues. This chapter offers suggestions on how clinicians can: (a) help clients move toward a positive body image, and (b) facilitate awareness of their own body image experiences which can impact client interventions. Commonly asked questions along with answers are included as well as specially created assignments to promote increased self-awareness in the clinician. It is recommended that the clinician review this chapter before proceeding with the rest of the workbook. | Chapter 2: Client and Reader Preparation is specifically designed for the client engaged in body image work with a clinician or for the interested reader who would like to learn about how to move toward positive body image. This chapter includes information on problem identification, how to prepare for body image work, core values, character strengths, purpose, goals, and committed action (and more!). Commonly asked questions along with answers are included as well as specially created assignments to promote increased self-awareness. It is recommended that the client/reader review this chapter before moving on to other chapters. | ||
|
II. The Journey Toward Positive Body Image (Chapters 4–22) | Theory and Research | Each content chapter includes an overview of a particular body image topic complete with up-to-date information from researchers and clinical experts from around the world in one source. A definition of the body image topic is offered along with theory and research on the topic. Clinicians can use these sections in various ways: (a) read to increase own knowledge, (b) offer as recommended readings to interested colleagues, (c) share highlights with clients during interventions, and/or (d) encourage clients to read on their own to discuss during future interventions. References are included at the end of chapter for the clinician who is interested in reading the original citations. | Each content chapter includes an overview of a topic of body image based on information from experts. Clients/readers can read the information as well as share with important others (family, friends, and partners) to increase understanding and sensitivity to body image issues. Clients in therapy can share relevant topics with their clinician. | |
| Talking Points | Talking points can be used to start a conversation on specific body image topics during interventions with clients. | Clients can circle talking points to address during treatment interventions. | Readers can journal about relevant talking points. | |
| Goals and Objectives | Sample goals and objectives that we have used in the care of our own clients are offered for treatment plans. The goals and objectives reflect various theoretical orientations. Clinicians can work collaboratively with clients to select relevant goals and objectives based on individual needs and preferences. | Sample goals and objectives are offered related to change. Goals are desired outcomes that are broadly defined, while objectives are smaller achievable steps towards goals. Clients can check relevant goals and objectives to include in treatment. | The listed goals and objectives provide guidelines for the body image journey. Goals are desired outcomes that are broadly defined, while objectives are smaller achievable steps towards goals. Readers can check relevant goals and objectives to work toward. | |
| Additional Resources | Books, workbooks, websites, and more are offered as additional resources to deepen understanding of the body image topics in areas that extend beyond the scope of this workbook. | |||
| Assessments | Most chapters include at least one assessment that corresponds with the theme of the body image topic that has been authorized for use by the original cited author(s). Some of the assessments were slightly modified to be inclusive of gender fluidity, improve clarity, and increase relevance for a range of client concerns. Interpretive scores are presented. Clinicians can use assessments in various clinical pursuits: (a) to determine client progress (beginning, middle, end of treatment), (b) to tailor treatment goals and objectives unique to the client, (c) to educate about different aspects and/or nuances of a topic, (d) to open dialogue about related topics, (e) to increase client self-awareness that can translate into change, (f) to sharpen treatment focus, (g) to inform homework assignments, and (h) to demonstrate objective response to treatment interventions. Integration of these assessments can be beneficial for those clinicians who are required to demonstrate a client’s response to treatment to an external entity (e.g., accrediting body, third party payor). Clinicians can complete assessments for their own personal growth. If clinicians wish to use the assessments for research purposes, they will need to contact the original authors. | Most chapters include an assessment focused on a topic of positive body image. Clients and readers can complete the assessments at various points throughout the positive body image journey. Guides for how to interpret high, medium, and low scores are presented. Comparing the scores between timepoints is a useful way to determine progress. | ||
| All assessments include corresponding applications to facilitate self-awareness via thought-provoking comments and questions. Clinicians can use the applications: (a) to stimulate dialogue during interventions, (b) to identify future treatment interventions, and/or (c) to encourage clients to complete as take-home assignments. Clinicians can complete assessment applications for their own benefit. | All assessments include applications to guide and deepen reflection by way of thought-provoking comments and questions. | ||
| Assignments | The purpose of the assignments is to apply and extend information on the body image topics. Different formats are offered to be of interest to a wide range of individuals: open ended-questions, journal entries, thought experiments, behavioral experiments, and more. Clinicians can integrate assignments in the following ways: (a) serve as talking points during clinical interventions for education purposes, (b) complete during clinical interventions, and/or (c) assign as homework between interventions. Additionally, the same assignments can be completed at the beginning and end of treatment to assess change and progress. Clinicians can complete assignments for their own benefit. | The purpose of the assignments is to apply and deepen information on body image. Different formats are offered: open ended-questions, journal entries, thought experiments, behavioral experiments, and more. Clients/readers can choose which ones to complete based on interest, paying attention to themes that may emerge. The assignments can be completed multiple times to review change and progress. Also, clients/readers can share either the completed assignments or the themes from the assignments with important others (family, friends, partners). Additionally, clients/readers can invite important and trusted others to also complete the assignments with the goal to share ideas after. | ||
| This chapter serves as a wrap-up to the workbook. Intentional activities are offered along with encouragement to develop a plan to maintain them in daily life. Clinicians can reinforce the use of the activities with clients along with completion of the final assignment that highlights journey reflections. Clinicians can review this chapter for their own benefit. | This chapter serves as a wrap-up to the workbook. Intentional activities are offered along with encouragement to develop a plan to maintain positive body image gains and prevent setbacks. Clients/readers can review this chapter when needing a resource to get back on track toward positive body image. | ||
Applicability and Limitations
We are honored for the opportunity to create this workbook and intend for it to be applicable to a range of people by:
Including scholarly works from reputable resources around the world.
Ensuring that samples of people with various identities are recognized and highlighted.
Using the term “they” throughout the workbook to acknowledge that anyone can experience body image concerns regardless of gender identity.
Integrating currently acceptable language to describe groups of people, acknowledging that this language is rooted within a Westernized lens and may not appeal to all.
We also understand that the field of positive body image is relatively young, there is still much to be learned, and what is understood as relevant today will likely morph over time. As a result, we acknowledge the following limitations along with our efforts to address them.
Some of the information in this workbook may be interpreted as complicated and dense. We have tried to present the information so that it is accessible for the general reader.
We promote “body acceptance” throughout the workbook while acknowledging that this experience may not be fully 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 ultimately body acceptance. We encourage future research endeavors to focus specifically on positive body image in transgender and gender nonconforming individuals in order to fully appreciate and honor these experiences.
We mindfully refrained from integrating trauma-focused content in the workbook. This decision was based on the collective philosophy that trauma-focused issues are most appropriately addressed within a therapeutic context, in which the client’s unique needs and experiences are honored. Trauma-focused therapy necessitates assessment by a trained clinician to determine the appropriate stage of trauma work and to offer a recommended treatment modality based on the client’s unique trauma history and treatment goals. It is important to note that those with histories of trauma may experience additional concerns related to their bodies such as self-protection, intimacy, body awareness, body trust, and body control. We encourage clinicians and clients to tailor the treatment tools, assessments, applications, and assignments within this workbook as clinically indicated to best fit the experiences of the client. Additionally, we recommend discretion when selecting workbook interventions in order to promote the client’s sense of personal choice, validation, and empowerment throughout this process.
Be the Change!
As mentioned in our guiding beliefs, we believe that change is necessary at numerous levels to lower the incidence of body image issues and to simultaneously promote positive body image. This workbook specifically targets change at the individual level by teaching skills to recognize and resist harmful body-related messages while also promoting self-acceptance. Individuals can then create a rippling effect of change by inspiring loved ones, friends, community members, and others to move toward positive body image. Ultimately this change can permeate at a societal level. For example, individuals who apply the skills from this workbook can get others involved by discussing the harms of weight stigma and the benefits of body acceptance, mentor others to have a positive body image, boycott companies that perpetuate weight stigma, and engage in social action in many other ways.
We envision a collective effort of challenging appearance ideals and combating weight stigma; a movement toward what really matters. We, the authors, commit to promoting body acceptance within society, and we hope to inspire you (clinicians, clients, and readers) to join us in this mission. We are excited that you are taking this step with us!
